Health & Medicare Basics

Medicare is senior health insurance program for those over 65, people with specific disabilities who are under the age of sixty-five, or people with End Stage Renal Disease. There are four parts to Medicare. Part A (hospital) is given to everyone who receives Medicare, most often. A monthly premium for this service is usually not expected. Part B (medical) is associated with a monthly premium. Parts C (Medicare Advantage Plans) include Part A and B and most often also have prescription coverage attached. A monthly premium is maintained for health and prescription coverage. Part D (prescription drug coverage) often, but not always, contain a monthly premium. Your Medicare card will include all plans associated with you.

Before obtaining Medicare you may want to decide which plan is best for you. The Original Medicare Plan is termed as a fee-for-service plan which is managed by the Federal Government. All individuals are put into this plan until they choose another form of Medicare plan. Medicare Advantages Plans are established by private companies. They offer a wider variety of choices and most often have significant benefits. They provide all of your hospital (Part A) and medical (Part B) needs. Some may also offer you prescription drug coverage (Part D). These plans vary as to what they may offer and/or expect. They may only be applied to certain doctors, hospital, or clinics and some may require a monthly premium to accommodate the extra benefits. Aside from Medicare Advantage Plans there are also Medicare Cost Plans, Demonstration/Pilot Programs, and PACE (Programs of All-inclusive Care for the Elderly) offered. Prescription drug coverage varies depending on the particular Medicare plan.

You will be in the Original Medicare Plan at the beginning of your enrollment unless you specify otherwise. The general rules for this plan are basic: You must use your red, white, and blue Medicare card whenever you require health care. Your coverage per treatment depends on Part or B status. You may go to any physician, supplier, hospital or other facility as long as it’s enrolled in Medicare. You are responsible for your deductible before Medicare pays its portion. You need to join a Prescription Drug plan before being eligible for those services. You will receive a Medicare Summary Notice each month. This does not mean you are always eligible for a payment check. However, it will express whether one will be issued. It will also list in detail any services which you required and whether a bill is owed for those specific services. Be aware that New Medicare premium rates become effective each year in January. You will receive notification of these changes in December if you receive Social Security or Railroad Retirement Board benefits.

In some, but not all, cases a health care supplier will let you know if something isn’t covered by Medicare. In this case, they would likely have you sign an agreement that you will pay for the service not covered by Medicare. This is called an Advanced Beneficiary Notice and it will explain what services are not covered by Medicare so you can decide appropriately whether or not to accept those particular services.

The Original Medicare Plan has limited coverage and is better served when accompanied with additional plans. However, if you choose to use only the Original Medicare alternative please educate yourself fully on the current status of what this plan offers and what will be expected of you. The care you take in doing so can only prove to benefit your health.